Provider Demographics
NPI:1740726728
Name:CENTURY GI MEDICAL, PLLC
Entity type:Organization
Organization Name:CENTURY GI MEDICAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAROUTIOUNIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:212-307-1017
Mailing Address - Street 1:25 CENTRAL PARK W
Mailing Address - Street 2:SUITE 1-Z
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7253
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25 CENTRAL PARK W
Practice Address - Street 2:SUITE 1-Z
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7253
Practice Address - Country:US
Practice Address - Phone:212-307-1017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-13
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYCERT# 3272261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3272OtherAMERICAN ASSOCIATION FOR ACCREDITATION OF AMBULATORY SURGERY FACILITIES, INC.